VNA of Ohio Blog

In June, Visiting Nurse Association of Ohio, in partnership with the ADAMHS Board of Cuyahoga County, launched a six-month pilot program to assist recovering opioid addicts manage their withdrawal symptoms following the initial week of detox. We talked to a few patients in the program and with Jackie, a detox nurse at the Stella Maris treatment facility. Thom Huggins, RN, is the psychiatric nurse leading the program and has been at VNA of Ohio for over 25 years.

Last year in our county, just under 600 people died of opiate overdoses. That was more than the combined total of deaths by motor vehicle accidents and by homicide. And that number was twice the number of people who died by overdoes the year before.

These are not nameless, faceless addicts dying in an alleyway in downtown Cleveland. These are our friends, our neighbors, our coworkers and our relatives.

“My name’s Frankie, and I’m a drug addict. I first smoked weed at 13 and progressed to alcohol and pharmaceutical drugs. I broke my hand and was prescribed Percocet. And then when the scripts stopped, I was addicted and didn’t even realize it. I started using heroin because they started cutting down on pills, and you couldn’t get pills anywhere. They were so expensive. I started doing heroin and crack cocaine.”

“I’m William, and I’m addicted to heroin going on three years now. Part of that, I’ve done a whole panel of drugs – cocaine, alcohol, marijuana.”

In response to the escalating number of drug-related deaths, VNA of Ohio has been asked to pilot the Ambulatory Withdrawal Management Program.

The program offers comfort medications to clients who have just completed a five-day detox program and are going to a residential treatment facility, which, historically, has not offered them medication.

“Detox was a big help, took the edge off,” said Frankie. “I came down to Stella Maris, and I could not sleep. I was getting delusional. I wanted to leave. I was bad, and you guys came in and saved me. And then you guys prescribed me some meds, and it took the edge off. It didn’t work the first night, but the second night, I finally got some sleep.”

Consequently, as the symptoms of withdrawal continue past detox – craving, cramping, muscle pain and diarrhea – patients just leave the facility to go use because they know they can feel better in minutes and since their brains are still sick, this can be an almost automatic response.

Our goal is to offer them medications, which will help them relax, help them focus and stay in treatment.

“They started me on this regiment, and it helped me get through,” said William. “The early days are the hardest, I think. To get your head clear and the physical withdrawal. It got me through to the point where I was able to learn. You know, in the beginning, your brain is really cloudy, emotions are coming back, it’s really difficult to absorb any type of information. And I was able to actually listen and gain some information on this disease of addiction.”

Jackie, RN, is a detox nurse at Stella Maris Cleveland. “Our detox provides a six-day detox. Sometimes a detox takes a little longer depending on what they’re withdrawing from. That is the biggest period of where we find relapse happening. You’re taking a substance away from an individual that has relied on it. There’s no coping skills that are developed within that short amount of time.”

Referrals to this program are made by the detox facility. Our plan is to offer patients medication that will allow them to relax, focus and stay in treatment. We have a very limited formulary – Gabapentin, Vistaril, Clonidine, Naltrexone, Doxepine. And I assure them that while they might not feel good, they will absolutely feel better. And, because of our relationship with a local pharmacy, we can guarantee the client the medication will be there tonight. I think this is a very valuable tool to be able to say to somebody ‘Just hang in there for a little bit and you will absolutely feel better tonight.’

Our program focuses on withdrawal management support so any medication we order, would only be for 2-4 weeks. What makes our program unique is that we also have a social worker that will work with a client – an adjunct to the treatment facility programming – to see what the VNA can do to assist the client to eliminate barriers to extended sobriety.

We know this is a public health crisis and the VNA of Ohio is proud to partner with the ADAMHS Board of Cuyahoga County in a system-wide plan whose simple goal is to keep the person in treatment and keep the person alive.

“In the way that it weaned me off worked out perfectly,” Frankie said. “Because in 30 days I was off all medications and I’m happy. I work a 12-step program – I don’t know how it works but I just keep doing what they tell me to do – and each day gets better and I get happier each day.”